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Yap CW, Yong C, Soon BKH. The different shapes of the fourth ventricle. Clin Radiol 2023; 78:875-884. [PMID: 37604738 DOI: 10.1016/j.crad.2023.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 07/11/2023] [Accepted: 07/17/2023] [Indexed: 08/23/2023]
Abstract
With a distinctive shape and surrounding anatomical structures, the fourth ventricle is located in the posterior cranial fossa. There are various pathologies, either developmental or acquired, that can present as a characteristic deformity of the fourth ventricle. Therefore, this paper will cover the anatomy of the fourth ventricle and correlate this to the various pathologies. The aim of this review is to improve the ability of the readers to recognise the change in shape and configuration of the fourth ventricle, enabling early detection of pathologies.
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Affiliation(s)
- C W Yap
- Department of Diagnostic Imaging, Level 2 Main Building, National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore.
| | - C Yong
- Department of Diagnostic Imaging, Level 2 Main Building, National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore
| | - B K H Soon
- Department of Diagnostic Imaging, Level 2 Main Building, National University Hospital, 5 Lower Kent Ridge Rd, 119074, Singapore
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Nguyen GV, Goncalves LF, Vaughn J, Friedman N, Wickland J, Cornejo P. Prenatal diagnosis of Poland-Möbius syndrome by multimodality fetal imaging. Pediatr Radiol 2023; 53:2144-2148. [PMID: 37423914 DOI: 10.1007/s00247-023-05712-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Revised: 06/21/2023] [Accepted: 06/22/2023] [Indexed: 07/11/2023]
Abstract
We describe prenatal diagnosis of Poland-Möbius syndrome using a combination of ultrasound and MRI. Poland syndrome was diagnosed based on absence of the pectoralis muscles associated with dextroposition of the fetal heart and elevation of the left diaphragm. Associated brain anomalies that led to the diagnosis of Poland-Möbius syndrome, included ventriculomegaly, hypoplastic cerebellum, tectal beaking, and a peculiar flattening of the posterior aspect of the pons and medulla oblongata, which has been reported by postnatal diffusion tensor imaging studies as a reliable neuroimaging marker for Möbius syndrome. Since abnormalities of cranial nerves VI and VII may be difficult to detect prenatally, careful attention to the appearance of the brain stem as illustrated in the current report may aid in the prenatal diagnosis of Möbius syndrome.
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Affiliation(s)
| | - Luis F Goncalves
- Department of Radiology, Phoenix Children's, 1919 E. Thomas Rd, Phoenix, AZ, 85016, USA.
- Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA.
- Department of Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA.
- Department of Radiology, Creighton University School of Medicine, Phoenix, AZ, USA.
| | - Jennifer Vaughn
- Department of Radiology, Phoenix Children's, 1919 E. Thomas Rd, Phoenix, AZ, 85016, USA
- Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University School of Medicine, Phoenix, AZ, USA
- Department of Neuroradiology, Barrow Neurological Institute at Phoenix Children's, Phoenix, AZ, USA
| | - Neil Friedman
- Department of Radiology, Phoenix Children's, 1919 E. Thomas Rd, Phoenix, AZ, 85016, USA
- Department of Neurology, Barrow Neurological Institute at Phoenix Children's, Phoenix, AZ, USA
| | - Jessica Wickland
- Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Neonatology, Phoenix Children's, Phoenix, AZ, USA
| | - Patricia Cornejo
- Department of Radiology, Phoenix Children's, 1919 E. Thomas Rd, Phoenix, AZ, 85016, USA
- Department of Child Health, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, University of Arizona College of Medicine, Phoenix, AZ, USA
- Department of Radiology, Creighton University School of Medicine, Phoenix, AZ, USA
- Department of Radiology, Mayo Clinic, Scottsdale, AZ, USA
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Gill AK, Raghavan A, Bhargava EK. Isolated congenital facial nerve agenesis. BJR Case Rep 2023. [DOI: 10.1259/bjrcr.20220119] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
An otherwise healthy 2 month old boy was referred to ENT for a congenital right facial palsy, with a birth history of difficult ventouse delivery. Initially, a traumatic cause was suspected, however subsequent MR 3D-FIESTA (T2 weighted) imaging demonstrated a right facial nerve agenesis with normal appearances of the remainder of the brain parenchyma, cranial nerves and parotid glands. There were no syndromic features or hearing difficulties. Isolated congenital nerve agenesis is a rare condition, with very few case reports available in the literature. Pre-natal 4D ultrasound imaging further supports the diagnosis. To our knowledge, this is the first published pre-natal ultrasound image of congenital facial nerve palsy. The infant has been referred for consideration of nerve reconstruction surgery, and is receiving multi-disciplinary input from ENT, Physiotherapy and Ophthalmology, the latter for prevention of exposure keratitis.
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Affiliation(s)
- Amarit Kay Gill
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, England
| | - Ashok Raghavan
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, England
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Rawhani R, Sharma K, Maertens P. Echoencephalography of Möbius sequence: A congenital cranial dysinnervation disorder with brainstem calcifications. J Neuroimaging 2023; 33:35-43. [PMID: 36349559 DOI: 10.1111/jon.13067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Revised: 10/26/2022] [Accepted: 10/29/2022] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND AND PURPOSE Möbius sequence (MBS) previously known as Möbius syndrome is a rare nonprogressive developmental defect of the rhombencephalon leading to congenital abducens (VIth) and facial (VIIth) nerve palsy. Echoencephalography is the first, safe, noninvasive, and cost-effective imaging modality available at bedside. No study on the use of echoencephalography in neonates for the diagnosis of MBS has been previously reported. METHODS In this single tertiary center study, more than 18,000 neonates underwent echoencephalographic imaging over the span of two decades. Imaging was performed through the anterior, posterior, and lambdoid fontanelles. All neonates found to have calcifications of brainstem tegmental nuclei underwent additional imaging studies. Each neonate with MBS was carefully examined by the same investigator. RESULTS Five neonates were shown to have punctate, bilateral, symmetrical tegmental pontine calcifications through all three acoustic windows. These calcifications extended caudally in most patients, and rostrally in 2 patients. Brainstem hypoplasia was best seen through the posterior fontanelle. Three out of five infants were noted to have brainstem hypoplasia with straightening of the floor of the fourth ventricle. In two children, facial collicular bulges and hypoglossal eminences were present. All five infants fulfilled clinical diagnostic criteria of MBS. In addition, a wide array of cerebral defects is identified. Echoencephalographic findings were confirmed by other imaging modalities. CONCLUSION Knowledge of echoencephalographic features of MBS should improve its early recognition. A detailed description of the various imaging phenotypes of MBS is necessary to characterize the etiology of this heterogeneous congenital cranial dysinnervation disorder.
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Affiliation(s)
- Ramez Rawhani
- Department of Pediatrics, University of South Alabama, Mobile, Alabama, USA
| | - Kamal Sharma
- Department of Pediatrics, Pediatric Critical Care Division, University of South Alabama, Mobile, Alabama, USA
| | - Paul Maertens
- Department of Neurology, Child Neurology Division, University of South Alabama, Mobile, Alabama, USA
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A rare cause of arterial hypertension in a child with developmental delay: Answers. Pediatr Nephrol 2022; 37:333-336. [PMID: 34668059 DOI: 10.1007/s00467-021-05302-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 09/16/2021] [Accepted: 09/17/2021] [Indexed: 10/20/2022]
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Tanaka Y, Maekawa T, Eura R, Hasegawa Y, Kubota M. Neurogenic bladder as a lurking complication in Moebius syndrome. Brain Dev 2022; 44:73-76. [PMID: 34400011 DOI: 10.1016/j.braindev.2021.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Revised: 07/07/2021] [Accepted: 07/15/2021] [Indexed: 10/20/2022]
Abstract
Moebius syndrome (MBS) is a congenital disorder characterized by facial and abducens palsy, sometimes accompanied with other cranial nerve palsies and comorbid conditions. Anatomical anomalies of the brainstem are assumed to be major etiologies of MBS. Its phenotypic presentation can be variable. We report a female patient with MBS who presented with neurogenic bladder (NB). She was born via normal vaginal delivery. At birth, she showed bilateral abducens palsy and right facial palsy. We diagnosed MBS by cranial computed tomography scan and magnetic resonance imaging. She had recurrent urinary tract infection. Hydronephrosis was noted on ultrasonography and bilateral vesicoureteral reflux (grade 5) on voiding cystourethrography. Urodynamic investigation showed detrusor overactivity and detrusor-sphincter dyssynergia, which follow the pattern of NB resulting from infrapontine-suprasacral lesions. Patients with MBS have lower brainstem dysfunction, and accordingly we should be aware of NB.
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Affiliation(s)
- Yuichiro Tanaka
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan.
| | - Takanobu Maekawa
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Rumiko Eura
- Department of Urology, Kagoshima University, Kagoshima, Japan
| | - Yuichi Hasegawa
- Division of Pediatric Urology, National Center for Child Health and Development, Tokyo, Japan
| | - Mitsuru Kubota
- Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
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Ozgen Mocan B. Imaging Anatomy and Pathology of the Intracranial and Intratemporal Facial Nerve. Neuroimaging Clin N Am 2021; 31:553-570. [PMID: 34689933 DOI: 10.1016/j.nic.2021.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
The facial nerve is one of the most complex cranial nerves, with motor, sensory, and parasympathetic fibers. A large spectrum of congenital, inflammatory, vascular, and neoplastic processes may affect one or more segments of the nerve. Customized use of computed tomography and magnetic resonance imaging combined with good understanding of the nerve anatomy and relevant clinical/surgical key points is crucial for appropriate assessment of facial neuropathy. This article reviews the anatomy of the intracranial and intratemporal facial nerve, and the imaging features of the most frequent disorders involving those segments of the nerve.
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Affiliation(s)
- Burce Ozgen Mocan
- Department of Radiology, University of Illinois at Chicago, 1740 West Taylor Street, MC 931, Chicago, IL 60612, USA.
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Rootman MS, Dotan G, Konen O. Neuroimaging in Children with Ophthalmological Complaints: A Review. J Neuroimaging 2021; 31:446-458. [PMID: 33615595 DOI: 10.1111/jon.12842] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 11/27/2022] Open
Abstract
Pediatric patients are commonly referred to imaging following abnormal ophthalmological examinations. Common indications include papilledema, altered vision, strabismus, nystagmus, anisocoria, proptosis, coloboma, and leukocoria. Magnetic resonance imaging (MRI) of the brain and orbits (with or without contrast material administration) is typically the imaging modality of choice. However, a cranial CT scan is sometimes initially performed, particularly when MRI is not readily available. Familiarity with the various ophthalmological conditions may assist the radiologist in formulating differential diagnoses and proper MRI protocols afterward. Although MRI of the brain and orbits usually suffices, further refinements are sometimes warranted to enable suitable assessment and accurate diagnosis. For example, the assessment of children with sudden onset anisocoria associated with Horner syndrome will require imaging of the entire oculosympathetic pathway, including the brain, orbits, neck, and chest. Dedicated orbital scans should cover the area between the hard palate and approximately 1 cm above the orbits in the axial plane and extend from the lens to the midpons in the coronal plane. Fat-suppressed T2-weighted fast spin echo sequences should enable proper assessment of the globes, optic nerves, and perioptic subarachnoid spaces. Contrast material should be given judiciously, ideally according to clinical circumstances and precontrast scans. In this review, we discuss the major indications for imaging following abnormal ophthalmological examinations.
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Affiliation(s)
- Mika Shapira Rootman
- Department of Radiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University
| | - Gad Dotan
- Ophthalmology Unit, Schneider Children's Medical center of Israel, Petac Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University
| | - Osnat Konen
- Department of Radiology, Schneider Children's Medical Center of Israel, Petah Tikva, Israel.,Sackler Faculty of Medicine, Tel-Aviv University
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Imaging of congenital cranial dysinnervation disorders: What radiologist wants to know? Clin Imaging 2020; 71:106-116. [PMID: 33189029 DOI: 10.1016/j.clinimag.2020.10.055] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 10/03/2020] [Accepted: 10/17/2020] [Indexed: 11/22/2022]
Abstract
We aim to review the imaging features of congenital cranial dysinnervation disorders. Characteristic imaging findings can define subtypes of these disorders through assessment of cranial nerves, extraocular muscles, orbital, and brain abnormalities. Duane retraction syndrome shows absent or hypoplasic 6th cranial nerve and preserved extraocular muscles (EOM). Mobius syndrome shows absent 7th and 6th cranial nerves, absence of facial colliculus, flattening of the dorsal aspect of the pons, hypoplasia of the pons and medulla, and flattening of the 4th ventricular floor. Congenital fibrosis of the extraocular muscles reveals unilateral or bilateral hypoplasia or aplasia of the 3rd cranial nerve, atrophy of superior rectus and levator palpebrae superioris muscles, and atrophy of the brainstem and cerebellar hemispheres. Horizontal gaze palsy and progressive scoliosis show characteristic split pons sign, butterfly medulla, absent facial colliculi, and spinal scoliosis. HOXA1 Mutations show a bilateral absence of 6th cranial nerves with the underdeveloped inner ear. Pontine Cap Tegmental Dysplasia shows ventral pontine hypoplasia, dorsal tegmental projection into the 4th ventricle, and variable cranial nerve deficits.
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Palma-Martínez DJ, Mejía-Quiñones V, Granados-Sánchez AM. Moebius sequence: radiological approximations to molecular disturbances: an overview. Radiol Case Rep 2020; 15:1225-1230. [PMID: 32577138 PMCID: PMC7301170 DOI: 10.1016/j.radcr.2020.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/29/2022] Open
Abstract
Moebius sequence is one of the rarest congenital cranial nerve abnormalities. Approximately 300 cases have been recorded in medical literature usually from single case report. Frequently characterized by either partial or complete agenesis of the VI and VII cranial nerves, Moebius sequence is also accompanied by vascular abnormalities and other alterations such as an aberrant or hypoplastic posterior fossa. We present 3 patients with Moebius sequence and their clinical and radiological features along with a discussion of their diagnostic approximations. The 3 patients (1 male and 2 females) with ages ranging from 24 days to 7 years in both outpatient and inpatient settings in a high complexity health center. Clinical and radiologic diagnosis with magnetic resonance imaging showed to be consistent with Moebius sequence. Moebius sequence initial diagnosis is based exclusively on nonunified clinical criteria, and there is an apparent genetic pattern of inheritance. Diagnostic clues include the child's inability for proper facial expressions, affectations in eye convergence, or diminished functional hearing. A radiological approach through the use of specific MRI sequences is often warranted in order to not only approximate cranial nerve abnormalities but also accompanying structural malformations.
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Affiliation(s)
- Daniel José Palma-Martínez
- General practitioner, Fundación Valle del Lili, Av. Simón Bolívar - Carrera 98 # 18 - 49, Cali - Colombia
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